Four-Weekly Benzathine Penicillin G Provides Inadequate Protection against Acute Rheumatic Fever in Some Children

Area of Science:

• Cardiology
• Infectious Diseases
• Pediatrics

Background:

• Acute rheumatic fever (ARF) is a serious autoimmune disease following streptococcal infection.
• Benzathine penicillin G (BPG) prophylaxis is crucial for preventing ARF recurrences.
• Identifying factors contributing to ARF recurrence despite adherence to BPG is essential for effective management.

Purpose of the Study:

• To investigate ARF recurrences in individuals adhering to BPG prophylaxis.
• To analyze the timing of BPG administration in relation to ARF recurrence.
• To identify potential risk factors for breakthrough ARF episodes.

Main Methods:

• Analysis of ARF recurrence data from Australia's Northern Territory (2012-2017).
• Calculation of Days at Risk (DAR) preceding ARF onset for individuals on BPG.
• Examination of BPG dosing timing for individuals with no DAR.

Main Results:

• 169 ARF recurrences were analyzed; median DAR was 29 days in the preceding 8 weeks.
• 87% of recurrences occurred after more than 7 DAR.
• Five percent (8 recurrences) occurred with no DAR, primarily in individuals under 16 years.

Conclusions:

• Delayed BPG doses are the most common cause of recurrent ARF.
• Timely BPG administration does not always prevent ARF recurrence, especially in younger individuals.
• There is a need for improved methods to identify high-risk individuals for recurrent ARF.